In normal pressure hydrocephalus, which clinical triad is classically described?

• A. Headache, fever, neck stiffness.
• B. Seizures, weakness, aphasia.
• C. Gait disturbance, urinary incontinence, and cognitive impairment.
• D. Visual loss, diplopia.

Answer: (C)

Disruption of frontal–subcortical circuits from ventriculomegaly produces a recognizable pattern: gait disturbance, urinary incontinence, and cognitive impairment. Gait change is usually the first and most prominent feature, often described as a magnetic or shuffling gait with difficulty initiating steps and turning. Cognitive impairment is subcortical in nature, with slowed processing and impaired executive function. Urinary symptoms progress from urgency to incontinence as frontal control over the bladder declines. Imaging typically shows ventricles enlarged out of proportion to sulci, and some patients improve after CSF removal, highlighting the reversible component. The other options reflect patterns more typical of meningitis (headache, fever, neck stiffness), stroke or seizure disorders (seizures, weakness, aphasia), or optic/ocular motor issues (visual loss, diplopia), not the classic triad of normal pressure hydrocephalus.